Practice Environments, Locum Tenens, Workplace

Locums Life: So Many Choices

The practice of emergency medicine is awesome: It is broad, it is intense, knowledge-based, and packed with emotion - and all of that eventually can be exhausting. But being able to pack up leave (a la locum tenens practice) can help you stay fresh.

Editor's Note: After early ABEM certification in the late 1970s, Paul Weinberg of ER Doc Tips was drawn to the intense but fulfilling practice at a high-volume, high-acuity urban trauma center in Orange County, California, from 1976-2006. For Dr. Weinberg, retirement is just a phase. Now he travels the country, continuing his career in EDs, large and small, quiet and busy.

The practice of emergency medicine is awesome: it is broad, intense, knowledge-based, and packed with emotion – and all of that eventually can be exhausting. After so many years of effort to achieve an EM position, the thought of leaving the field can be discouraging and filled with social and economic dread.

Rough Road of Burnout
The early symptoms of burnout, once identified, should create some questions about what is next on the path. One suggestion that can work is to enter the locum tenens circuit. Locums allow for choices in your practice life; choices that are so needed to avoid the emotional damage often created by the daily and nightly old-school practice in a single site.

After a brief trial of not practicing medicine, I returned to a locums-only practice. My time away from medicine was used to develop non-medical income sources, read novels, and re-bond with my middle-school aged children.

The overarching concept was one of sustainability. I had many years of productive life ahead, and one of my self-discoveries during my time away from medicine was that, despite my varied and many business interests, at my core I am a doctor. This insight was slow in recognition but deep in emotion.

Its acceptance allowed me to continue along the medical path with a sense of contentment. I needed to find a way to achieve longevity and satisfaction within the practice of emergency medicine. I chose to go the locums path.

Smooth Sailing with Locum Tenens
Entering the locums practice is a bit like the first day on a new rotation. You know the nuts and bolts of the practice, but the details are to be learned.

Procedural components are important to getting the job done, and you do not yet know the system. That procedural knowledge, once learned, allows you to work in an efficient manner and not feel frustrated with the delay between knowledge of what you want to do and its completion. Do not underestimate the power of the electronic medical record to make you feel like chewing the eraser off a pencil.

So, it worked for me. Here are a few areas of workplace-specific improvements to consider:

  • Shift length: You can find positions that have shift lengths from 8 hours to 24/7.
  • Shift time: Yes, you can work the shift time you want to work. The democratic group-share requirement or required buy-in times can be avoided by being a locums provider. For me, it was the overnight shift (too old, enzyme systems worn out). I would decline the locum position if it required overnights. This did reduce some opportunity, but it allowed for longevity.
  • Schedule: The children’s school vacation schedule ruled. I wanted time off with them! I was able to control my work availability to allow for that pleasure.
  • Income: Almost always you will be paid an hourly rate, open to some negotiation. You can choose a production model of more charges per patient or patients per hour. i.e. earn through intensity of service or duration on duty.
  • Committee Service: Gone! 
  • Location: Limited by the effort required to get licensed in different states. Allows a chance to see different regions and explore their offerings.

The Downside
Impediments of locums include burdensome applications and paperwork for each hospital. Remember from high school geometry, “Things equal to the same thing are equal to one another”? Well, the hospital credentialing community does not believe in that corollary, so electronically save all your required documentation (health records, practice history, malpractice, immunizations, licensing, CME, identification, certifications, etc.) so it can be easily found and emailed to those who ask for it. And remember, as you work in more sites and for a longer time you have a more complicated history to share with those who require the information.

Related Articles

Working with Nurses and Alternate Practitioners

Working with Nurses and Alternate Practitioners The following is an excerpt from EMRA's popular Medical Student Survival Guide, edited by Kristin Harkin, MD and Jeremy Cushman, MD. In this chapter ab

Burnout in the Emergency Department: An Interview with Zachary Olson, MD, Creator of EM Clerkship Podcast

Want to beat burnout? There's plenty of general advice available. But sometimes you need real-life perspective. For that we spoke with Zachary Olson, MD.